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Prophylactic sclerotherapy for esophageal varices in high-risk cirrhotic patients selected by endoscopic and hemodynamic criteria: a randomized, single-center controlled trial.
Endoscopy. 1994 Nov; 26(9):734-40.E

Abstract

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results, in spite of an initial positive controlled trial. We designed therefore a new study in which only 89 of 396 investigated patients were randomized to sclerotherapy (44 patients) or a control group (45 patients). The admission criteria were: no history of variceal bleeding, the presence of high risk varies, i.e., varices of degrees III and IV with minivarices on the surface of them, and portal pressure over 16 mmHg. Sclerotherapy sessions were performed at 0, 7, 14, 21, and 28 days, until the varices were reduced in size and completely covered by fibrous tissue. Follow-up endoscopy was performed at four-month and thereafter at six-month intervals. The control patients underwent repeated clinical investigation and endoscopy at six-month intervals. Bleeding episodes were treated by emergency endoscopic sclerotherapy in both groups, whenever possible. The mean follow-up was 33 months. The results were analyzed using Student's t-test and the log-rank test. Variceal bleeding occured in 11 sclerotherapy patients (25%) and 34 controls (75.6%) (p < 0.05). The overall mortality was 25% (11 patients) among the sclerotherapy patients and 69% (31 patients) in the controls (p < 0.01). Prophylactic endoscopic sclerotherapy was able to prolong survival in Child-Pugh classes A and B, but not in C. It is concluded that prophylactic endoscopic sclerotherapy does reduce the incidence of first variceal bleeding in cirrhotic patients, and is able to prolong survival if only high-risk patients are selected and the treatment is performed by endoscopic experts.

Authors+Show Affiliations

Department of Surgery, Heinz Kalk Hospital, Bad Kissingen, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7712967

Citation

Paquet, K J., et al. "Prophylactic Sclerotherapy for Esophageal Varices in High-risk Cirrhotic Patients Selected By Endoscopic and Hemodynamic Criteria: a Randomized, Single-center Controlled Trial." Endoscopy, vol. 26, no. 9, 1994, pp. 734-40.
Paquet KJ, Kalk JF, Klein CP, et al. Prophylactic sclerotherapy for esophageal varices in high-risk cirrhotic patients selected by endoscopic and hemodynamic criteria: a randomized, single-center controlled trial. Endoscopy. 1994;26(9):734-40.
Paquet, K. J., Kalk, J. F., Klein, C. P., & Gad, H. A. (1994). Prophylactic sclerotherapy for esophageal varices in high-risk cirrhotic patients selected by endoscopic and hemodynamic criteria: a randomized, single-center controlled trial. Endoscopy, 26(9), 734-40.
Paquet KJ, et al. Prophylactic Sclerotherapy for Esophageal Varices in High-risk Cirrhotic Patients Selected By Endoscopic and Hemodynamic Criteria: a Randomized, Single-center Controlled Trial. Endoscopy. 1994;26(9):734-40. PubMed PMID: 7712967.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic sclerotherapy for esophageal varices in high-risk cirrhotic patients selected by endoscopic and hemodynamic criteria: a randomized, single-center controlled trial. AU - Paquet,K J, AU - Kalk,J F, AU - Klein,C P, AU - Gad,H A, PY - 1994/11/1/pubmed PY - 1994/11/1/medline PY - 1994/11/1/entrez SP - 734 EP - 40 JF - Endoscopy JO - Endoscopy VL - 26 IS - 9 N2 - Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results, in spite of an initial positive controlled trial. We designed therefore a new study in which only 89 of 396 investigated patients were randomized to sclerotherapy (44 patients) or a control group (45 patients). The admission criteria were: no history of variceal bleeding, the presence of high risk varies, i.e., varices of degrees III and IV with minivarices on the surface of them, and portal pressure over 16 mmHg. Sclerotherapy sessions were performed at 0, 7, 14, 21, and 28 days, until the varices were reduced in size and completely covered by fibrous tissue. Follow-up endoscopy was performed at four-month and thereafter at six-month intervals. The control patients underwent repeated clinical investigation and endoscopy at six-month intervals. Bleeding episodes were treated by emergency endoscopic sclerotherapy in both groups, whenever possible. The mean follow-up was 33 months. The results were analyzed using Student's t-test and the log-rank test. Variceal bleeding occured in 11 sclerotherapy patients (25%) and 34 controls (75.6%) (p < 0.05). The overall mortality was 25% (11 patients) among the sclerotherapy patients and 69% (31 patients) in the controls (p < 0.01). Prophylactic endoscopic sclerotherapy was able to prolong survival in Child-Pugh classes A and B, but not in C. It is concluded that prophylactic endoscopic sclerotherapy does reduce the incidence of first variceal bleeding in cirrhotic patients, and is able to prolong survival if only high-risk patients are selected and the treatment is performed by endoscopic experts. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/7712967/Prophylactic_sclerotherapy_for_esophageal_varices_in_high_risk_cirrhotic_patients_selected_by_endoscopic_and_hemodynamic_criteria:_a_randomized_single_center_controlled_trial_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-1009085 DB - PRIME DP - Unbound Medicine ER -